NPIMap

Organization Active NPI

Greenville Nursing & Rehabilitation Center, LLC

  • Skilled Nursing Facility
  • Greenville, IL
National Provider Identifier
1235649054
Registry record updated Oct 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0046680 Issued in IL
Legal business name
GREENVILLE NURSING & REHABILITATION CENTER, LLC
Practice address
400 E Hillview Ave
Greenville, IL 62246-2607
Phone
(618) 664-1622
NPI assigned
Oct 6, 2017
Last updated
Oct 6, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Scott E StoutNPI 1952874075
Title
Ceo
Phone
(618) 294-8696

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0046680 IL Primary

Addresses

Primary practice location

400 E Hillview Ave
Greenville, IL 62246-2607

Mailing address

105 S Commercial St Ste 1
Harrisburg, IL 62946-1939
Phone (618) 294-8696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171226000633 IL Part A Provider - Skilled Nursing Facility 9739447624 Practice locations: Greenville, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235649054. Details of each certification follow.

Skilled nursing facility certification: CCN 145909

Legal name
GREENVILLE NURSING & REHABILITATION CENTER, LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Oct 11, 1996
Last certification
Aug 22, 2024
Beds
90
Ownership / control type
Limited Liability Corporation
Multi-facility organization
WLC Managment Firm
Most recent change of ownership
Dec 1, 2017
Organization structure
LLCProprietary
Incorporated
Oct 2, 2017 in IL
Enrollment address
400 E Hillview Ave
Greenville, IL 62246-2607
Nursing home name
GREENVILLE NURSING & REHAB
Affiliated entity
WLC MANAGEMENT FIRM

Care Compare: Nursing home

Medicare Care Compare
Listed as
Greenville Nursing & RehabCCN 145909 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 11, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9056.5 residents per day on average
Chain
WLC Management Firm18 facilities in the chain
Penalties (3 years)
1Fines totaling $10,874

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2144816Greenville Nursing & Rehabilitation Center L L C400 E Hillview Ave, Greenville, IL 62246Certificate of waiverFeb 22, 2028

National Provider Directory

National Provider Directory

Locations

105 S Commercial St
Ste 1
Harrisburg, IL 62946

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Scott E Stout Individual 5% Or Greater Indirect Ownership InterestCeo Dec 1, 2017 100%
Corporate OfficerCeo Dec 1, 2017 100%
Operational/Managerial ControlCeo Dec 1, 2017 100%
Shelly Vonburg Individual Operational/Managerial ControlAdministrator Aug 22, 2022 100%
John a Flick Individual Contracted Managing EmployeeMD; Jan 1, 2021
WLC Management Firm LLC Organization, Harrisburg, IL LLC, For-profit 5% Or Greater Direct Ownership Interest Dec 1, 2017 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 12

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507248000000",
    "number": "1235649054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S COMMERCIAL ST STE 1",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629461939",
            "telephone_number": "618-294-8696",
            "fax_number": "618-294-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E HILLVIEW AVE",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622462607",
            "telephone_number": "618-664-1622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE NURSING & REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-06",
        "last_updated": "2017-10-06",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-294-8696",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0046680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, IL

Sources for this page

Verify at the official NPI Registry.